Healthcare Provider Details

I. General information

NPI: 1497765028
Provider Name (Legal Business Name): LAWRENCE KAPLAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 CAMINO ALTO STE 100
MILL VALLEY CA
94941-2900
US

IV. Provider business mailing address

61 CAMINO ALTO STE 100A
MILL VALLEY CA
94941-2900
US

V. Phone/Fax

Practice location:
  • Phone: 415-381-2020
  • Fax: 415-381-0774
Mailing address:
  • Phone: 415-459-2358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6475
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: